Hypertension, the Kuna, and the Epidemiology of Flavanols

Department of Nutrition , Harvard University, Cambridge, Massachusetts, United States
Journal of Cardiovascular Pharmacology (Impact Factor: 2.14). 02/2006; 47 Suppl 2(Supplement 2):S103-9; discussion 119-21. DOI: 10.1097/00005344-200606001-00003
Source: PubMed


A low sodium diet has often been implicated in the protection of low blood pressure populations from hypertension, but several other dietary factors, including those as yet unidentified, may also be involved. The Kuna Indians of Panama are free of hypertension and cardiovascular disease, but this is changing with migration to urban areas. We compared the indigenous diet of Kuna Indians living on remote islands in Panama (Ailigandi), whose lifestyle is largely hunter-gatherer, with those who have moved to a suburb of Panama City (Vera Cruz). Between April and October 1999, members of a Kuna research team administered a 118-item food frequency questionnaire to133 adult Kuna from Ailigandi and 183 from Vera Cruz. Single 24-hour urine collections and nonfasting blood samples were obtained. The Kuna in Ailigandi reported consuming a 10-fold higher amount of cocoa-containing beverages, 4 times the amount of fish, and twice the amount of fruit as urban Kuna (P<0.05 by t test). Salt added was ample among those living in Ailigandi and Vera Cruz according to both self-report (7.1+/-1.1 and 4.6+/-0.3 tsp weekly) and urinary sodium levels (177+/-9 and 160+/-7 mEq Na/g creatinine), respectively. The low blood pressure of island-dwelling Kuna does not seem to be related to a low salt diet. Among dietary factors that varied among migrating Kuna, the notably higher intake of flavanol-rich cocoa is a potential candidate for further study.

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    • "function (Wang-Polagruto et al., 2006) and reduce the incidence of atherosclerotic diseases (McCullough et al., 2006). These results are in agreement with data from human studies that showed the antihypertensive properties of cocoa polyphenols (Taubert et al., 2007). "
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    ABSTRACT: The effect of Theobroma cacao (cocoa) polyphenol on isoproterenol-induced myocardial infarction in Wistar rats was studied. Polyphenol was extracted from cocoa using hydroalcohol solvent. Twenty four rats divided into six groups of four rats each were used for the study. Groups 3, 4, 5 and 6 were pretreated with the extract (300, 500 and 700 mg/kg) and 100 mg/kg of atenolol respectively before administration with isoproterenol. Group 1 served as normal control and group 2 was administered with isoproterenol without treatment. The activities of marker enzymes, aspartate amino transferase (AST), alanine amino transferase (ALT) and lactate dehydrogenase (LDH) in both serum and heart tissue homogenate were assayed. Cocoa polyphenol ameliorated the leakage of marker enzymes from the heart into the serum and also restored the levels of these enzymes in the cardiomyocytes. Histological examination of heart tissues revealed marked ability of the extract to reduce the progression of infarct lesions.
    Full-text · Article · Aug 2015 · Journal of Applied Pharmaceutical Science
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    • "Epidemiological evidence suggests that a polyphenolrich diet may help to prevent BP from increasing and reduce high BP levels in people with normal-to-high BP or hypertension [9]. On the other hand, daily consumption of flavanol-rich cocoa decreased BP [21], possibly due to the activation of vascular NO synthase [10]. Cocoa flavanols "
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    ABSTRACT: Background and aim Hypertension is one of the main cardiovascular risk factors in the elderly. The aims of this work were to evaluate if a one-year intervention with two Mediterranean diets (Med-diet) could decrease blood pressure (BP) due to a high polyphenol consumption, and if the decrease in BP was mediated by plasma nitric oxide (NO) production. Methods and Results An intervention substudy of 200 participants at high cardiovascular risk was carried out within the PREDIMED trial. They were randomly assigned to a low-fat control diet or to two Med-diets, one supplemented with extra virgin olive oil (Med-EVOO) and the other with nuts (Med-nuts). Anthropometrics and clinical parameters were measured at baseline and after one year of intervention, as well as BP, plasma NO and total polyphenol excretion (TPE) in urine samples. Systolic and diastolic BP decreased significantly after a one-year dietary intervention with Med-EVOO and Med-nuts. These changes were associated with a significant increase in TPE and plasma NO. Additionally, a significant positive correlation was observed between changes in urinary TPE, a biomarker of TP intake, and in plasma NO (Beta= 4.84; 95% CI: 0.57 to 9.10). Conclusions TPE in spot urine sample was positively correlated with plasma NO in Med-diets supplemented with either EVOO or nuts. The statistically significant increases in plasma NO were associated with a reduction in systolic and diastolic BP levels, adding to the growing evidence that polyphenols might protect the cardiovascular system by improving the endothelial function and enhancing endothelial synthesis of NO.
    Full-text · Article · Sep 2014 · Nutrition Metabolism and Cardiovascular Diseases
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    • "The Kuna, an indigenous group who lives predominantly on small islands off the coast of Panama consume a large amount of natural cocoa drinks, and are nearly free of hypertension and cardiovascular disease. In contrast, Kuna who migrate to Panama urban sites lose this advantage, as they are no longer able to maintain their habit of drinking cocoa.(11) Recent epidemiological evidence suggests that ingestion of flavan 3-ols monomers reduces the risk of coronary heart disease.(12,13) "
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    ABSTRACT: Flavan 3-ols, a type of polyphenolic substance, are distributed in a number of plant foods. Of these foods, chocolate is very rich in flavan 3-ols as flavan 3-ol monomers, (+)-catechin and (-)-epicatechin, and the oligomers as procyanidins. There is evidence that cacao products containing flavan 3-ols have the potential to contribute to the risk reduction of cardiometabolic disorders according to recent epidemiological or intervention studies. This review focuses on recent advances in research on the ability of flavan 3-ols to reduce the risk of cardiovascular disease as a result of improving metabolic syndrome risk factors and these mechanisms.
    Full-text · Article · May 2013 · Journal of Clinical Biochemistry and Nutrition
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